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Spondylolisthesis with sciatica. Magnetic resonance findings and chemonucleolysis

P C Rijk1, R Deutman, T E de Jong

  • 1Martini Hospital, Department of Orthopaedics, Groningen, The Netherlands.

Clinical Orthopaedics and Related Research
|May 1, 1996
PubMed
Summary

Chemonucleolysis effectively treated lumbar disc herniations causing sciatica in patients with spondylolisthesis. Most patients with L5 spondylolisthesis experienced good or excellent outcomes, with minimal complications observed.

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Area of Science:

  • Orthopedics
  • Neurosurgery
  • Radiology

Background:

  • Bilateral lumbar isthmic spondylolisthesis often presents with unilateral sciatica.
  • Disc protrusion at the spondylolisthesis level is a common finding.
  • Nerve root compression can result from central or foraminal disc herniations.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of chemonucleolysis in patients with bilateral lumbar isthmic spondylolisthesis and unilateral sciatica.
  • To assess the impact of chemonucleolysis on disc protrusion and nerve root compression using magnetic resonance imaging (MRI).

Main Methods:

  • Fifteen patients with bilateral lumbar isthmic spondylolisthesis and unilateral sciatica underwent MRI.
  • All patients had disc protrusion at the spondylolisthesis level.

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  • Treatment involved chemonucleolysis, followed by a 19-month average followup.

    • Main Results:

    • Chemonucleolysis was performed without complications in all 15 patients.
    • Good or excellent outcomes were reported in 10 of 12 patients with L5 spondylolisthesis and 1 of 3 with L4 spondylolisthesis.
    • MRI follow-up showed decreased dural sac deformation in 4 patients and no distinct foraminal changes in most.

    Conclusions:

    • Chemonucleolysis appears to be a safe and effective treatment for sciatica secondary to disc protrusion in patients with lumbar isthmic spondylolisthesis.
    • Outcomes are more favorable for patients with L5 spondylolisthesis compared to L4.
    • MRI findings suggest potential for reduced disc herniation and nerve compression post-treatment.